Management of Post‑Resuscitation Care Following Cardiac Arrest
Post‑cardiac arrest care aims to stabilise the patient after return of spontaneous circulation (ROSC), limit secondary brain injury from ischaemia-reperfusion, identify and treat reversible causes (particularly coronary occlusion), and plan early destination and specialist involvement. Care should begin immediately and be protocolised in the ED with senior oversight (Resus UK; NICE HTG710; RCEM).
Key principles
- Follow an ABC approach continuously: secure airway, optimise oxygenation/ventilation and haemodynamics, prevent secondary insults to the brain, and search for reversible causes.
- Use continuous monitoring and early invasive/advanced monitoring where available (arterial line, EtCO2, echocardiography).
- Avoid premature prognostication; use a multimodal assessment once confounders (sedation, temperature management, neuromuscular blockade) have resolved (Resus UK).
- Involve senior clinicians early and use local protocols for destination decisions (cardiac arrest centre, cath lab, ECMO services).
Immediate priorities after sustained ROSC
- Secure airway protection: intubate comatose patients (GCS ≤ 8) or those who cannot protect their airway; confirm tube position with waveform capnography (Resus UK).
- Oxygen: start 100% O2 during initial stabilisation, then titrate to targets once SpO2/ABG available.
- Monitoring: continuous ECG, SpO2, EtCO2 in ventilated patients; frequent NIBP or invasive arterial monitoring.
- Circulation: establish reliable vascular access (large‑bore peripheral ± central), assess for haemodynamic instability, and treat hypotension promptly.
- Investigations: immediate 12‑lead ECG, ABG/lactate, blood glucose, electrolytes, troponin, chest X‑ray after intubation...